Anticipation of complications after laparoscopic cholecystectomy: prediction of individual outcome

Abstract

Complication rates after a laparoscopic cholecystectomy are still up to 10%. Knowledge of individual patient risk profiles could help to reduce morbidity. The aim of this study is to create risk profiles for specific complications to anticipate on individual outcome. Individual patient outcome for a specific post-operative complication was assessed from a retrospective database of two major teaching hospitals, using uni- and multivariable analyses. A total of 4359 patients were included of which 346 developed one or more complications (8%). Five risk profiles were found to predict specific complications: older patients (>65year) are at risk for pneumonia (OR 7.0, 95% CI 3.3-15.0, p<0.001) and bleeding (OR 2.2, 95% CI 1.2-3.9, p=0.014), patients with acute cholecystitis are at risk for intra-abdominal abscess (OR 5.9, 95% CI 3.4-10.1, p<0.001), bile leakage (OR 3.6, 95% CI 2.0-6.6, p<0.001) and pneumonia (OR 3.5, 95% CI 1.6-7.6, p<0.002), previous history of cholecystitis is predictive for wound infection (OR 5.1, 95% CI, (2.7-9.7), p<0.001), intra-abdominal abscess (OR 6.1, 95% CI 2.8-13.8, p<0.001), post-operative bleeding (OR 4.8, 95% CI 2.1-11.1, p<0.001), bile leakage (OR 7.2, 95% CI 3.4-15.4, p<0.001) and pneumonia (OR 3.9, 95% CI 1.3-11.9, p=0.018), pre-operative ERCP is predictive for intra-abdominal abscess (OR 3.3, 95% CI 2.0-5.7, p<0.001), post-operative bleeding (OR 2.1, 95% CI 1.2-3.9, p=0.058) and pneumonia (OR 3.8, 95% CI 1.9-7.8, p=0.001), and converted patients are at risk for wound infection (OR 4.0, 95% CI 2.1-7.7, p<0.001) and intra-abdominal abscess (OR 3.5, 95% CI 1.6-7.7, p=0.002). Individual risk prediction of outcome after laparoscopic cholecystectomy is feasible. This facilitates individual pre-operative doctor-patient communication and may tailor surgical strategies.